Respiratory function during pressure support ventilation.

Pressure support ventilation (PSV) is a pressure assist form of mechanical ventilatory support that augments the patient's spontaneous inspiratory efforts with a clinician selected level of positive airway pressure. To understand the effects of PSV on respiratory function, experiments were performed on 15 stable patients requiring synchronized intermittent mandatory ventilation (SIMV), as well as on a mechanical model simulating these patients' ventilatory systems. In the clinical study, gas exchange, airway pressures, blood pressure and heart rate were measured while SIMV was replaced by enough PSV to approximate the baseline SIMV tidal volume (VT). Measurements were repeated while this PSV level was then reduced in three 5 cm H2O steps every 10 to 15 minutes. It was found that PSV was a reasonable form of mechanical ventilatory support in patients with spontaneous ventilatory drives. It improves patient comfort, reduces the patient's ventilatory work, and provides a more balanced pressure and volume change form of muscle work to the patient. The clinical significance of these properties during the weaning process remain to be determined.

[1]  J. Mead,et al.  The control of respiratory frequency. , 1960, Annals of the New York Academy of Sciences.

[2]  S. Semple,et al.  The respiratory muscles, mechanics and neural control , 1971 .

[3]  J. Modell,et al.  Intermittent Mandatory Ventilation: An Evaluation , 1974 .

[4]  G. Sieck,et al.  The ventilatory muscles. Fatigue, endurance and training. , 1982, Chest.

[5]  M. Becklake,et al.  The relationship of oxygen cost of breathing to respiratory mechanical work and respiratory force. , 1961, The Journal of clinical investigation.

[6]  Peter V. Karpovich,et al.  Physiology of muscular activity , 1960 .

[7]  H. Pontoppidan,et al.  Acute respiratory failure in the adult , 1972 .

[8]  William Woolf Mushin,et al.  Automatic ventilation of the lungs , 1969 .

[9]  Belman Mj.  Respiratory failure treated by ventilatory muscle training (VMT). A report of two cases. , 1981 .

[10]  and,et al.  Respiratory muscle fatigue : a cause of respiratory failure ? , 2022 .

[11]  P. Macklem,et al.  Respiratory muscle fatigue: a cause of respiratory failure? , 1977, Clinical science and molecular medicine.

[12]  P. Macklem,et al.  Clinical manifestations of inspiratory muscle fatigue. , 1982, The American journal of medicine.

[13]  S. Meij,et al.  Cardiopulmonary response to inspiratory pressure support during spontaneous ventilation vs conventional ventilation. , 1985, Chest.

[14]  William W. L. Glenn,et al.  Ventilatory support by pacing of the conditioned diaphragm in quadriplegia. , 1984, The New England journal of medicine.

[15]  V. Sahgal,et al.  When should respiratory muscles be exercised? , 1983, Chest.

[16]  H. Pontoppidan,et al.  Acute respiratory failure in the adult. 2. , 1972, The New England journal of medicine.

[17]  Sears Ta.  Breathing: a sensori-motor act. , 1971, The Scientific basis of medicine annual reviews.

[18]  P. Macklem,et al.  Fatigue of inspiratory muscles and their synergic behavior. , 1979, Journal of applied physiology: respiratory, environmental and exercise physiology.

[19]  D. F. Rochester,et al.  Respiratory muscle failure. , 1983, The Medical clinics of North America.

[20]  P. Macklem,et al.  The Respiratory Muscles: Mechanics, Control, and Pathophysiology , 2015 .

[21]  H RAHN,et al.  Mechanics of breathing in man. , 1950, Journal of applied physiology.

[22]  P. Macklem,et al.  The effect of training on strength and endurance of the diaphragm in quadriplegia. , 1980, The American journal of medicine.

[23]  P. Fahey,et al.  Oxygen cost of breathing. Changes dependent upon mode of mechanical ventilation. , 1985, Chest.

[24]  D Stagg,et al.  Interrelationships of the volume and time components of individual breaths in resting man. , 1975, The Journal of physiology.

[25]  J. Karpel,et al.  Inspiratory muscle resistive training in respiratory failure. , 1985, The American review of respiratory disease.

[26]  J. Marini,et al.  The inspiratory work of breathing during assisted mechanical ventilation. , 1985, Chest.

[27]  A. Paintal,et al.  Vagal sensory receptors and their reflex effects. , 1973, Physiological reviews.

[28]  F. J. Clark,et al.  On the regulation of depth and rate of breathing , 1972, The Journal of physiology.

[29]  A. C. Bryan,et al.  Ventilatory muscle endurance training in normal subjects and patients with cystic fibrosis. , 2015, The American review of respiratory disease.

[30]  J. Luce,et al.  Intermittent mandatory ventilation. , 1981, Chest.

[31]  D. Leith,et al.  Ventilatory muscle strength and endurance training. , 1976, Journal of applied physiology.